What is the recommended 24-hour fluid intake for a healthy 11 kg child?

24-Hour Fluid Requirement for an 11 kg Child

For a healthy 11 kg child, the recommended 24-hour maintenance fluid requirement is 1,050 mL (approximately 1 liter) per day, calculated using the Holliday-Segar formula. 1, 2

Calculation Method

The Holliday-Segar formula remains the standard approach for calculating pediatric maintenance fluid requirements, based on the principle that water needs parallel energy expenditure at approximately 1 mL per 1 kcal 1:

• First 10 kg of body weight: 100 mL/kg/day 1, 2
• Next 10 kg (11-20 kg): 50 mL/kg/day 1, 2
• Each kg above 20 kg: 25 mL/kg/day 1

For Your 11 kg Child:

• First 10 kg: 10 kg × 100 mL/kg/day = 1,000 mL/day
• Remaining 1 kg: 1 kg × 50 mL/kg/day = 50 mL/day
• Total: 1,050 mL per 24 hours 1, 2

Hourly Rate Equivalent

If administering fluids continuously, this translates to:

• First 10 kg: 4 mL/kg/hour = 40 mL/hour 2, 3
• Remaining 1 kg: 2 mL/kg/hour = 2 mL/hour 2, 3
• Total hourly rate: 42 mL/hour 2

Fluid Type Selection

Use isotonic fluids (0.9% saline or balanced crystalloids) for maintenance hydration, especially during the first 24 hours if the child is acutely ill. 1, 2 The American Academy of Pediatrics recommends isotonic fluids based on Level 1+ evidence showing that hypotonic fluids significantly increase the risk of hospital-acquired hyponatremia and potentially fatal hyponatremic encephalopathy 1.

Important Clinical Considerations

When to Adjust Volume:

Increase fluid requirements in the following situations 1:

• Fever
• Hyperventilation or hypermetabolism
• Gastrointestinal losses (vomiting, diarrhea)

Decrease fluid requirements (restrict to 65-80% of calculated volume) when 1, 2:

• Risk of increased antidiuretic hormone (ADH) secretion
• Critically ill or acutely ill status
• For severe conditions (heart failure, renal failure, hepatic failure), restrict to 50-60% of calculated volume 1, 2

Total Fluid Accounting:

All fluid sources must be included in the daily total to prevent fluid overload 1, 2:

• IV maintenance fluids
• Blood products
• IV medications and line flushes
• Enteral intake (oral or tube feeding)

This is critical because maintenance fluid was identified as the largest contributor (37.4%) to total fluid intake in critically ill children, and failure to account for all sources leads to "fluid creep" and fluid overload 4.

Monitoring Requirements

Reassess fluid balance and clinical status at least daily 1, 2:

• Monitor serum electrolytes, especially sodium levels 1, 2
• Assess for signs of dehydration or fluid overload 3
• Fluid overload (>10% cumulative positive fluid balance) independently predicts increased morbidity, mortality, and prolonged mechanical ventilation 1

Common Pitfalls to Avoid

• Do not use hypotonic fluids for maintenance in acutely ill children due to hyponatremia risk 1
• Do not forget to account for all fluid sources - medications and line flushes contribute significantly to total intake 1, 4
• Do not continue calculated rates without reassessment in changing clinical conditions 3
• Do not exceed osmolality correction rates - induced changes in serum osmolality should not exceed 3 mOsm/kg/hour 1